Provider Demographics
NPI:1114611696
Name:COLIBRI PLLC
Entity Type:Organization
Organization Name:COLIBRI PLLC
Other - Org Name:COLIBRI PLLC- CENTRO DE SALUD MENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INDIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:980-333-7422
Mailing Address - Street 1:3439 VICTORIA BROOK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-4257
Mailing Address - Country:US
Mailing Address - Phone:980-333-7422
Mailing Address - Fax:
Practice Address - Street 1:1515 MOCKINGBIRD LN # 420
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3236
Practice Address - Country:US
Practice Address - Phone:980-304-3203
Practice Address - Fax:980-246-3971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty